EMR: Good or Bad?

A physician blogging at the NYT describes what she sees as glitches with the electronic medical records (EMR) system.

To me, what she points out to be the problems, if they are what she sees as the major problems, seem fairly minor. One of the problems was the limitation the system puts on the number of characters they physician can input into an assessment field. This problem, from a programmer's point of view is not a difficult one. Viewed from a higher view, it is a matter of altering parts of the program and changing the allowed character numbers to one that is determined to be sufficient. It shouldn't be a major problem from a storage point of view either, as plain text doesn't take up much storage space. Of course, there could be other reasons behind the initial design and decision to make the limit of 1,000 characters. Still, this is a simple issue that can be resolved by a better communication with the physicians/management and software developers/management.

The second "glitch" Dr. Ofri points out is:

...Nobody, for example, leafs through a chart anymore, strolling back in time to see what has happened to the patient over many years. In the computer, all visits look the same from the outside, so it is impossible to tell which were thorough visits with extensive evaluation and which were only brief visits for medication refills. In practice, most doctors end up opening only the last two or three visits; everything before that is effectively consigned to the electronic dust heap.

The root of this discomfort is also, I think, similar to the first problem. It could be simply a matter of the physician being resistant to change (for, people are almost always unappreciative of changes to any part of a frequently visited web site or blog, even if that means the new design will have a better functionality, let alone a change from a paper-based work that has been in place for decades to a computer based one).

If resistance to change is really not the major problem, then the issue can be easily resolved or improved, again, with more (or better) communication among the users and the designers of the programs. It seems to me just a matter of enhancing the interface of the program to make it visually easier for the physician to see what Dr. Ofri would like to see -- make a color based button for each visit on the top right hand corner of the window to show if this visit were extensive or brief, etc. In fact, I see a better outcome from such design than the paper-based record. For example, assuming that an extensive visit in the traditional visit meant that there were more paper work for that particular day than others, the major visual indicator of the type of visit would have been the size of the pile of papers. On the other hand, adding a brief/extensive visit field to indicate the type of visit in the electronic system would make it easier to visualize and access. More helpful detail would be made easily accessible through the EMR than would have been through the traditional paper-based record system.

A Rare HIV Cure

A formerly HIV positive man who had undergone a blood stem cell transplant to treat leukemia, is reportedly clear of the virus:

It is a rare case of fortunate coincidences though, and it may not be very practical: the donor happens to have had an HIV resistance gene mutation, the procedure is complex and expensive.

Still, a glimpse of hope and perhaps a lead towards different approaches of researching HIV infection cure.

Can malaria be eradicated?

A report by BBC citing a Lancet article says may be not:

Efforts to eradicate malaria in some countries may be counter-productive, an international team of researchers suggest.

In the Lancet, they suggest some countries, particularly in sub-Saharan Africa, may be better pursing a policy of controlling the disease.

They also criticise the World Health Organization (WHO) for not providing adequate direction.

But a WHO spokesman said beating malaria must remain the ultimate goal.

I will try to locate the Lancet article and post more on this later.

On a related news, Dideir Drogba has just been diagnosed with malaria:

Story from The Independent here.

In a classic malaria case, it took weeks (and even possibly months) to detect what a "mystery virus" Drogba had contacted. Who would have thought a Premier League player living the highest standards of life in London would contact malaria? Now that I've learned form the same article that Drogba will be able to receive treatments for 48 hours to keep him fit enough to play in the next game, I personally think this is a blessing in disguise. This will further raise the awareness of the brutal disease worldwide. It will also give Drogba, already a figure known for his humanitarian work especially in his country of Ivory Coast, a strong personal drive to push the cause even further.

I've got to say that the man has an immense strength: he played almost a full game just two days before the announcement of the diagnosis, even though the symptoms of malaria had already kicked in at least a month ago. According to the Independent, he "has been suffering from headaches and high temperatures off and on for the past month." He also played in at least two other games in the past two weeks alone.

More to come on malaria soon...

Vision Challenges

I had my eye exam yesterday, after about 3 years. The last time I had one, I was fitted with a pair of eyeglasses for the first time in my life. And it was good. I had my eyes examined because I started to miss my bus because I couldn't clearly read the bus number, and because I had hard time judging the distance to curbs when making left turns while driving. Failing to read street names and numbers, while others could clearly do so was also another reason.

On my way home wearing my first pair of glasses, I was awed by the level of detail I was able to see. I could now read, not only the letters and the numbers on a license plate of a car moving away from the bus I'm on, I could also read the smaller letters on the license plate edge -- those letters that usually advertise the car dealership from which the car was bought, etc. My delight was such that I questioned if the level of detail that I was able to visually perceive my surrounding was normal. Could I be walking with a binocular on?

My trip yesterday was long overdue, as the last eye physician had asked me to see another eye physician within a year the latest. In addition to the regular eye exam, I am also being trained to use contact lenses. I definitely didn't foresee how challenging it would be to put those delicate lenses into an even more delicate part of the body. I was never brave enough to touch any part of my eyeball with my fingers or any other object, and so it was expected that I would never be brave enough to put a lens on it. It must have taken me at least a half hour for each of the two trials that I had to do before I left the eye-doctor's office.

Today, I put my contacts on, with some, but less challenge. Aside from the frustration of putting them on, what I found surprising was the level of detail that I was able to see things with. Again. This time, looking down from the window of the kitchen in my high-rise apartment, I was able to see things that I didn't see yesterday. This is not because I paid more conscious attention today than I did yesterday. My view yesterday was deliberate, too, as I have just moved in to the place and I have been introducing myself to the new view from my daily-to-be standing location. At a long distance, I could see that there was a highway-like road with big, green signs hanging. I could see the cars speeding there, and I can almost read what the signs said, from a distance that I would have thought was amazing just yesterday. Cars and were also moving on a street that seems to join the highway, also at a distance that I never saw cars just yesterday. What's more, I can even see the colours of the window curtains of the building next to mine.

Despite the challenges of putting them on, contact lenses and my newly corrected vision has been a pleasurable change.

Thoughtful Qoute

"Look at the worldly, at those who set themselves above the people of God-- have they not distorted the image of God and His truth? They have science, but science contains nothing that doesn't come through the senses. The spiritual world, the nobler side of man's being, has been rejected altogether, banned as it were triumphantly, perhaps even with hatred. The world has proclaimed freedom, now more loudly than ever; but what do we find in that freedom of theirs? Nothing but enslavement and suicide! The world says: 'You have needs -- satisfy them. You have as much right as the rich and the mighty. Don't hesitate to satisfy your needs; indeed expand your needs and demand more.' This is the worldly doctrine of today. And they believe that this is freedom. The result for the rich is isolation and suicide, for the poor, envy and murder; for while the poor have been handed all these rights, they have not been given the means to enjoy them. Some claim that the world is gradually becoming united, that it will grow into a brotherly community as distances shrink and ideas are transmitted through the air. Alas, you must not believe that men can be united in this way. To consider freedom as directly dependent on the number of man's requirements and the extent of their immediate satisfaction shows a twisted understanding of human nature, for such an interpretation only breeds in men a multitude of senseless, stupid desires and habits and endless preposterous inventions. People are more and more moved by envy now, by the desire to satisfy their material greed, and by vanity. Giving dinners, riding in private carriages, occupying high social positions, and having myriads of servants -- these are considered so important by some that they devote their whole lives to acquiring them and sacrifice for their sake their love for their fellow men, and sometimes kill themselves if they cannot obtain what they believe they must have. It is the same with those who are not rich. And, as to the poor, who cannot satisfy their needs at all, they just drown their envy of others in alcohol...That is why the idea of service to mankind and brotherly love has been dying out in the world; indeed, now it is often sneered at, for what can a man do who has become the slave of the innumerable needs and habits he has invented for himself? He lives in his separate little world, and doesn't care about the great world outside. The result of all this is that, today, when more material goods have been accumulated than ever, there is less joy."


The elder Zosima in Fyodor Dostoevsky's The Brothers Karamazov.

Quebec, Where are My 10 Pounds?

Upon reflection, what I find to be one of the good things about my trip to Quebec is that it can be used as a period of time for which I can make lots of observations and come up with explanations to things that need explanations. It is like being sent away for an experimental "living trip." Unlike regular day-to-day life that seems like an endless (well, relatively speaking) time of sleep and awake with some activity in between, the trip has a definite, short, time a defined space, a defined goal and a defined set of activities. The fact that it was a memorable trip makes it even easier to find explanations with fairly good level of accuracy.

So here goes my weight issue.

When not inflating my repetition numbers, I am usually navigating around the gym, looking through the windows or hopping on to the scale. So the gym is where I watch my weight, literally.

I noticed in my second week of stay in Quebec that I had lost 10 pounds. At first, I thought the scale wasn't accurate, but a friend confirmed that it actually was fairly accurate. Then I blamed the Kg to lb conversion. There must have been an error there. I thought the fact that my weight has not fluctuated much in the last 4 or 5 years made me deny the reality, which I confirmed after I came back from the trip. I have indeed lost 10 pounds during my 5 week trip to Quebec.

But how is that possible?

Stress? What stress?

Eating habits? May be. My eating habits were changed, as I had to eat almost entirely outside, and had no food that I could grab and eat in my room. At the same time, I did not spend much time in my room. My most frequent meals included: morning breakfast was usually a big meal with eggs, bacon and toast; lunch pasta with beef sauce along with a fruit; another lunch option was chicken/fish/beef with rice and a soup + juice. Dinner was either skipped because lunch was eaten late or eaten outside wherever I happen to be -- usually light food. Fast food was avoided as much as possible. In fact, the only fast food outing I can think of was to Ashton's for a poutine dinner. Even for a poutine, I noticed that the food I ate in Quebec didn't have "enough salt" so I had to add extra salt to it -- even to a food whose base is essentially French fries!

It must be the activities. There were lots of them. Many of them involved walking: I made a habit of walking on the streets of Old Quebec whenever possible, and was virtually walking there every Sunday evening. Walking was the most common of the activities. We walked for nearly two hours when we did our mandatory weekly photograph trips; we walked for 7 kilometers in total when we had a class trip; we walked from the pub in down town to our residence when the bus wasn't coming early enough...the list goes on. And then there was the hiking up the Jacques-Cartier Parc mountain, and there was the swimming, and the kayaking, and the other swimming...and the dancing, too. There were also occasional gym visits, and an intense soccer game.

It must be the activities then, and the walking, and the dancing and swimming, not Quebec, that took my 10 pounds away.

Tip Ping

A couple of odd incidents occurred in the last couple days that involved an unusual clash between customers and servers.

The first one was at a bar close to campus. I purchase my first drink using my credit card. I wrote a one dollar tip for my five dollar drink. That's a 20 per cent tip, if we were to consider the "standard" tipping percentage. I was ready to order my second drink from the same server, when the server told me, even before I indicated my mode of payment, that, "to just let you know, in Quebec, when you make payments using credit cards, you don't pay for the taxes, but I do". So I'd have to make up for it using tips. In other words, he was telling me that I was not a generous tipper, and so I need to be one on my next payment. This struck me as odd by the obvious fact that I was being asked, in the most direct way possible, to tip more. The other fishy thing about the server's statement was the accuracy of the claim itself-- that he "pays the taxes." Usually at bars like that, the prices for drinks that you are told or are on the menu, are the exact amount that you pay (in addition to the universal tips, of course). So was the guy making that stuff up as a way of telling me to tip more? Either way, the simple fact that he directly suggested that I tip more was very irritating. The bar-setting and timing didn't encourage me to express my irritation, so I simply assured him that the taxes will be taken care of.

The second incident took place just this afternoon. I had lunch with a friend from the program at a place called Diana Cafe Restaurant. We were very satisfied with the setting of the restaurant and the food. We had lots of positive words to say about it throughout our entire stay, until my usually calm and collected friend started to speak in irritated tone and even cursing on our way out, after having paid his due using debit. What happened? Well, it turns out, our server demanded, in an even more explicit way, that my friend pays a tip of at least five dollars in addition to his $27 food and drink charges. This set my friend off to a mode of anger that erased all the good stuff that we had about the restaurant. It also made me pleased for having made a two dollar tip to the guy (had I been aware of the encounter before making my payment, it would have been zero dollars), but it raised a number of tipping questions: do we really have to tip?

At the expense of sounding like a cheap penny-pincher (I am not. I am just a student with a small pocket-- see my credit card use above), I have to also mention yet another tipping trouble that I had a few days back. This time, it wasn't the server who was the trouble, but another client. I made a remark to a client I had a small talk with at the counter that the server took too much time to take my order (because she was busy drinking and chattering with other clients) and so she didn't deserve more than what I left (a dollar and twenty five cents). This set the client off. She asked loudly and rather rhetorically, if that was how much I tipped where I am from. I told her may be not, but this tip was particularly "deserved" because the server did not serve me well. This set the woman even more on fire, and I gestured to add some money to the tip to see if she would calm down. Her friend told me that there was not point in doing that as the damage was already done and that I might as well save my money. So I did.

Strictly speaking, I don't see the point in tipping. The only reason I can think of that sort of justifies leaving a tip is the sense of guilt the consumer may feel for having treated the server/waitress, etc somewhat as a servant. Otherwise, what it is that we give extra money for? The server is doing exactly what they are paid to do: serve customers. Why do I have to give extra money to the bar tender that just took a few seconds to open a bottle of beer and hand it to me, and a few more seconds to give me the unnecessarily coin-rich change?


What about we look at it this way: this server is a hired person paid to do what they do: serve customers. By buying stuff at the location, the consumer is already contributing towards the server's job security. When the prices are set for the food, drink or other products, they are surely to include "service fees" that will go towards the server's wage. This is especially true at the heavily overpriced bars and restaurants that I've visited in Quebec City.

I never imagined that a supposedly voluntary act of rewarding a hired person would be taken so for granted to a level that it is explicitly demanded.